COMMUNITY EXPERIENCE ANN L. ENGELLAND, MD HARRISON AND MAMARONECK SCHOOL DISTRICTS BARNARD COLLEGE HEALTH SERVICE

What we thought then…. Run them around following head injury Awaken patient every two hours Shine bright light in eyes to check for ?? RTP often in same game (dings and bell ringers)

What we think we know now… Rest is mainstay Sleep is therapy Recognize photophobia Sit out ‘til symptom- free

This is about effecting change…

Is it about creating a better helmet?

“When eight-year-olds are hitting each other-in tackle practice—with roughly the same G-forces as college players, what’s badly needed is a paradigm shift, a universal up-draft in thinking.” “This is your brain on football” by Paul Solotaroff Rolling Stone Magazine, January 2013

How do we do that?

How to make policy changes NOT JUST POLICY CHANGE ala NYState Guidelines NOT JUST by inducement from the Attorney General IT’s about CHANGE BY RELATIONSHIPS, sometimes one at a time

We can listen to Dr. Atul Gawande and others

My experience 5 schools: – 4 public school districts – 1 college Private practice Policy-making in four settings Book writing and blog Twitter, Facebook Google alerts

Who needs education? Community at large parents/hcp’s School /ad min/faculty School / Athletic personnel/ athletes Students at large

How to reach the audience

Ways to Teach Faculty meetings Staff in-services (health, athletics, guidance, social work, psych) Correct errors diplomatically Make it easy and use checklists

SECONDARY HEALTH OFFICE CONCUSSION CHECKLIST Student:________________________Grade:_______ Today’s Date:________ Date of Injury:_______________ Notified by:______________________ Description of injury:_______________________________________________ Current Sport:_____________Counselor:___________________ Date: _____ Concussion package mailed/given & discussed with parent. _____Add information on Database & PE alert list _____Signed parental consent received _____ teachers/counselors alerting of concussion or head injury _____Incident report if injury occurred on school property _____Baseline/Prior Impact on file? If yes then have student re-test when symptom free Part C or consult School MD to determine when to Impact _____Check medical chart for previous concussions: List Concussion Hx dates:_________________ _____If medical note necessary for school attendance – then advise Counselor need for Concussion Team Meeting ______Completed Part C returned – check w/ counselor to see how student is doing academically before sending School MD paperwork _____ School MD Post MTBI & medical paperwork & advise School MD of Information in Bold below & feedback from counselor/teachers RTL SECONDARY HEALTH OFFICE CONCUSSION CHECKLIST

More ways to teach Website development School newsletter Medical resources in community Psychiatric and Neuropsych resources Resource for the injured with guide to recovery

Films to view and show Head Games The Smartest Team Crash Reel United States of Football ?

What needs emphasizing Non-sports injuries are prevalent

What needs emphasizing Prevention starts in pre-season

What needs emphasizing DON’T FORGET TO ASK ABOUT HISTORY

What to emphasize Exercise and Fitness, Team sports are important to a healthy childhood

What needs emphasizing Holistic and individualized approach to each injury is required

What needs emphasizing College level: no NCAA umbrella rules!

What NOT to emphasize New helmets, bells and whistles Different equipment ImPACT testing unless very experienced Long term disability risk ? Beware of snake oil salespeople

“Now promise me you will all be very careful.”

It’s All in Your Head: Everyone’s Guide to managing Concussions Ann Engelland, MD